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Chest. 2020 Jan 23. pii: S0012-3692(20)30123-9. doi: 10.1016/j.chest.2019.11.050. [Epub ahead of print]

Lower vs Higher Fluid Volumes During Initial Management of Sepsis: A Systematic Review With Meta-Analysis and Trial Sequential Analysis.

Author information

1
Department of Intensive Care, Copenhagen, Denmark; Centre for Research in Intensive Care, Copenhagen, Denmark. Electronic address: tine.sylvest.meyhoff@regionh.dk.
2
Department of Intensive Care, Copenhagen, Denmark; Centre for Research in Intensive Care, Copenhagen, Denmark.
3
Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Section of Anaesthesia and Intensive Care, Sweden.
4
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Centre for Research in Intensive Care, Copenhagen, Denmark.

Abstract

OBJECTIVE:

IV fluids are recommended during the initial management of sepsis, but the quality of evidence is low, and clinical equipoise exists. We aimed to assess patient-important benefits and harms of lower vs higher fluid volumes in adult patients with sepsis.

METHODS:

We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized clinical trials of IV fluid volume separation in adult patients with sepsis. We adhered to our published protocol; the Cochrane handbook; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; and the Grading of Recommendations Assessment, Development and Evaluation statements. The primary outcomes were all-cause mortality, serious adverse events (SAEs), and quality of life.

RESULTS:

We included nine trials (n = 637); all were published after 2015 and had an overall high risk of bias. We found no statistically significant difference between lower vs higher fluid volumes in all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.69-1.10; I2 = 0%; TSA-adjusted CI, 0.34-2.22) or SAEs (RR, 0.91; 95% CI, 0.78-1.05; I2 = 0%; TSA-adjusted CI, 0.68-1.21). No trials reported on quality of life. We did not find differences in the secondary or exploratory outcomes. The quality of evidence was very low across all outcomes.

CONCLUSIONS:

In this systematic review, we found very low quantity and quality of evidence supporting the decision on the volumes of IV fluid therapy in adults with sepsis.

TRIAL REGISTRY:

ClinicalTrials.gov; No.: NCT03668236; URL: www.clinicaltrials.gov.

KEYWORDS:

fluid therapy; intensive care; resuscitation; sepsis; septic shock

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